2006

The Lancet Reports 655,000 Excess Iraqi Deaths As A Consequence Of The Invasion

How do we judge the health of a free society? How do we distinguish the appearance of democracy from the reality?

There are no hard and fast rules, no scientific methodologies. But as a rule of thumb it is safe to suggest that we can learn much from a society's willingness to address the humanitarian crimes for which it is responsible.

In a totalitarian society, we would expect such a discussion to be absent in any meaningful sense. But in a genuinely free society, we would expect a thorough, detailed and unrestrained debate. Although this second expectation is itself based on an important assumption: namely, that individual freedom implies moral concern, a sense of responsibility for the suffering of others. We assume that to be a free human being means, also, to be free from the bonds of selfishness and indifference.

October 11 and 12 were significant dates, then, for anyone seeking to establish something of the truth of our own society. On October 11 news organisations began reporting the results of an article published by the Lancet medical journal: 'Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey.' The study was led by Gilbert Burnham of the prestigious Johns Hopkins Bloomberg School of Public Health in Baltimore. The survey itself was conducted by eight Iraqi doctors led by Riyadh Lafta of Al Mustansiriya University, Baghdad. The doctors collected data from 1,849 households comprising 12,801 individuals in 47 population clusters across Iraq. The survey findings were staggering:

"We estimate that, as a consequence of the coalition invasion of March 18, 2003, about 655 000 Iraqis have died above the number that would be expected in a non-conflict situation, which is equivalent to about 2·5% of the population in the study area. About 601 000 of these excess deaths were due to violent causes. Our estimate of the post-invasion crude mortality rate represents a doubling of the baseline mortality rate, which... constitutes a humanitarian emergency." (Gilbert Burnham, Riyadh Lafta, Shannon Doocy, Les Roberts, 'Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey,' http://www.thelancet.com/webfiles/images/journals/lancet/s0140673606694919.pdf)

The scientists estimate that the most probable number of excess deaths is 654,965. They also estimate, with 95 per cent certainty, that the actual number lies between 392,979 and 942,636.

It is important to note that the standard figure for Iraqi deaths offered by the mainstream media is that supplied by Iraq Body Count (IBC). At time of writing, the "maximum" IBC figure stands at 48,783. There has long been great confusion among journalists about exactly what this figure represents. Many believe it describes the maximum possible total of Iraqi dead, or of all Iraqi civilians killed. In fact it is the figure solely for Iraqi civilian victims of violence as reported by at least two (mostly Western) media as selected by IBC for use in their study.

So although the latest Lancet study measures a much broader range of deaths, the difference is nevertheless enormous, particularly for the many journalists who assume the studies measure much the same thing. Likewise, the Lancet figures must strike the public as astonishingly high given that they have been repeatedly reminded of IBC's 48,000 death toll and George Bush's 30,000 figure.

As we will see, the Lancet's latest study has inherent credibility. The reasons were explained in a rare US press editorial on the matter in the St. Louis Post-Dispatch (Missouri) on October 15:

"Here is one of the world's most respected medical journals publishing a peer-reviewed study by epidemiologists backed by Johns Hopkins University's School of Public Health, part of one of the world's most respected medical schools." ('Methodology in madness,' October 15, 2006)

In sum, a free press in a free society would simply +have+ to investigate this study in depth, if only to resolve the confusion of a bemused and concerned public in response to an inherently credible report.

The Front Pages

In the event, the story failed to appear on the front pages of most newspapers on October 12. We collected a pile of dailies that day and noted the following front pages:

Only the Independent and Guardian made the report their front page lead stories:

The Independent: '655,000 the toll of war in Iraq.'

The Guardian: 'One in 40 Iraqis killed since invasion.'

A LexisNexis database search (October 18) found that the words 'Jack Straw' and 'veil' have been mentioned in 348 articles over the last week. The words 'Madonna' and 'adoption' have been mentioned in 219 articles. The words 'Iraq' and 'Lancet' have been mentioned in 44 articles. The words 'Lancet' and '655,000' have been mentioned in eight national newspaper articles.

The Times devoted a third of a page to the Lancet story on page 45. The Daily Mail had three-quarters of a page on page 2. The Daily Express had a two-inch wide column on page 6 dwarfed by the adjacent story: '"Ageist" birthday cards banned from the office.' The Daily Telegraph had 422 words on page 5. The Financial Times had 609 words on page 7. Of these newspapers, only one has since published any follow up reporting or commentary - 35 words in the Financial Times as part of a round-up of the week's events on October 14.

The Observer devoted 43 words in a single sentence in a comment piece by Mary Riddell (October 15) and a single sentence in a news piece on page 8. The Independent on Sunday referred to the story in one sceptical paragraph in a comment piece by John Rentoul on page 40 and in one sentence of an article by Patrick Cockburn (October 15).

The Daily Mirror and Daily Star have made no mention of the report at all.

The Independent covered the story on October 12 in a news piece, an editorial, and in a brief examination of how Lancet editor Richard Horton "has turned a once-staid academic journal into a publication at the centre of a string of controversies". (Ben Russell, '"Lancet" back at centre of controversy,' The Independent, October 12, 2006) The Independent has since mentioned the story in two sentences on October 13 and October 18.

The Guardian gave 930 words to the story on October 12 in a news piece and 214 words in a brief explanation of the methodology behind the study. The paper also published a comment piece defending the report by Lancet editor, Richard Horton. Since then, there has been Ben Rooney's 200-word round-up of web-based debate on the story (October 13) and a single sentence in an article by Simon Tisdall (October 17). The Guardian also mentioned the study in an October 12 leader - in a single sentence. Remarkably this was an aside in a piece focusing on the "chaotic travesty" of Saddam Hussein's trial:

"Judicial procedure and decorum may seem irrelevant in a country that is reeling under seemingly unstoppable sectarian violence. Even if the human toll since March 2003 is less than the horrific, if contentious, new estimate of 655,000, Iraq seems to be bleeding to death and falling apart. Still, when Saddam was captured in December 2004, trying him was seen..." (Leader, 'Trials and errors,' The Guardian, October 12, 2006)

With the evidence of our own vast crimes before their eyes, that was all the Guardian editors had to say. Instead, the focus of their concluding paragraph was elsewhere:

"The old tyrant may be getting a far better deal than anything that existed when he was in charge. But that is not saying much. And it is not nearly good enough."

So much for the progressive credentials of the country's "leading liberal newspaper".

Huge Gaps - An Exchange With The BBC

The BBC linked to the story from the front page of its website. The BBC1 13:00 News (October 11) spent 19 seconds on the topic. On the 18:00 News celebrity anchor Natasha Kaplinsky described the figures as "shocking and controversial". Baghdad correspondent Andrew North reassured viewers: "It is only an estimate." On the News at Ten, anchor Huw Edwards explained that the report was "controversial" and that while the report was serious the figures were "controversial though". Reporter David Shukman declared: "We'll never know the figures, it's too dangerous [in Iraq]." The study, he added, had "weaknesses", such as "the margin of error".

Huw Edwards turned to world affairs editor John Simpson for his view. Simpson thought hard and concluded that it was "difficult to be certain" about the death toll. The figures were "possible", he said, but "nobody can tell".

George Bush's comment on the report, "The methodology is pretty well discredited", was widely broadcast and printed. A great moment in TV history was missed when journalists failed to seek clarification on the exact nature of the president's problem with the methodology.

In fact Bush's claim that the methodology had been discredited was a lie, as the people who told him what to say are surely well aware. Richard Brennan, head of health programmes at the New York-Based International Rescue Committee, told Associated Press:

"This is the most practical and appropriate methodology for sampling that we have in humanitarian conflict zones."

Brennan's group has conducted similar projects in Kosovo, Uganda and Congo. He added:

"While the results of this survey may startle people, it's hard to argue with the methodology at this point." (Malcolm Ritter, 'Bush Dismisses Iraq Death Toll Study,' Associated Press Online, October 12, 2006)

Professor Mike Toole of the Centre for International Health, Melbourne, said:

"The methodology used is consistent with survey methodology that has long been standard practice in estimating mortality in populations affected by war. For example, the Burnet Institute and International Rescue Committee (IRC) used the same methods to estimate mortality in the Democratic Republic of Congo. The findings of this study received widespread media attention and were accepted without reservation by the US and British governments. The Macfarlane Burnet Institute for Medical Research and Public Health's Centre for International Health endorses this study." (Toole, The Age (Melbourne), letters to the editor, October 14, 2006)

Richard Garfield, a public health professor at Columbia University who works closely with a number of the authors of the report, told the Christian Science Monitor:

"I loved when President Bush said 'their methodology has been pretty well discredited'. That's exactly wrong. There is no discrediting of this methodology. I don't think there's anyone who's been involved in mortality research who thinks there's a better way to do it in unsecured areas. I have never heard of any argument in this field that says there's a better way to do it." (Dan Murphy, 'Iraq casualty figures open up new battleground,' Christian Science Monitor, October 13, 2006)

John Zogby, whose New York-based polling agency, Zogby International, has done several surveys in Iraq since the war began, said:

"The sampling is solid. The methodology is as good as it gets. It is what people in the statistics business do." (Anna Badkhen, 'Critics say 600,000 Iraqi dead doesn't tally,' San Francisco Chronicle, October 12, 2006)

Zogby said similar survey methods have been used to estimate casualty figures in other conflicts, such as Darfur and the Congo. Zogby also noted that US critics accept the method for opinion polls, which are based on interviews with around 1,000 Americans in a country of 300 million people.

Frank Harrell Jr., chair of the biostatistics department at Vanderbilt University, called the study design solid and said it included "rigorous, well-justified analysis of the data". (Ritter, op., cit)

Steve Heeringa, director of the statistical design group at the Institute for Social Research at the University of Michigan, said:

"Given the conditions (in Iraq), it's actually quite a remarkable effort. I can't imagine them doing much more in a much more rigorous fashion." (Ibid)

BBC Newsnight interviewed Sir Richard Peto, Professor of Medical Statistics at the University of Oxford, who described the study as "statistically reliable". (Newsnight, October 11, 2006)

Professor Sheila Bird of the Biostatistics Unit at the Medical Research Council said:

"They have enhanced the precision this time around and it is the only scientifically based estimate that we have got where proper sampling has been done and where we get a proper measure of certainty about these results." (Channel 4 News, October 11, 2006)

Richard Horton, the editor of The Lancet, commented:

"It is worth emphasising the quality of this latest report, as judged by four expert peers who provided detailed comments to editors." (Clive Cookson and Steve Negus, 'Survey says 600,000 have died in Iraq war,' Financial Times, October 11 2006)

By contrast, Frederick Jones, a White House spokesman, commented that the Lancet "seems to be a medical organization that has politicized itself". (Julie Hirschfeld Davis, 'Bush disputes estimates of Iraqi deaths,' Baltimore Sun, October 12, 2006)

General George Casey, the commander of US forces in Iraq, commented:

"I have not seen the study. That 650,000 number seems way, way beyond any number that I have seen. I've not seen a number higher than 50,000. And so, I don't give that much credibility at all."

Any "controversy" surrounding the study is clear, then - professional epidemiologists and other experts in the field consider the report credible while the politicians and generals responsible for the bloodbath detailed in the study dismiss it out of hand.

No matter, BBC Online chose to focus on the "controversy", and alleged "huge gaps" in the study (October 12). We wrote to the BBC's world affairs correspondent Paul Reynolds, author of the article:

You cite critics of this week's Lancet report and of the earlier 2004 report: Michael O'Hanlon, Frank Kaplan, Margaret Beckett, George Bush and Gen George Casey. You also mention that the "IBC reaction to the Lancet report is awaited."

As BBC world affairs correspondent - a senior BBC journalist - what prevents you from approaching professional epidemiologists and other recognised experts in the field, such as Bradley Woodruff, Michael Toole, David Meddings, Richard Garfield and Patrick Ball? Why do you cite only the criticisms of non-experts in response to what is, after all, an extremely complex and involved field of scientific inquiry?

Best wishes

David Edwards

Reynolds replied:

"I quoted those people because they are players." (October 13, 2006)

We sent Reynolds some of the expert opinion cited above and asked him:

"Do you honestly believe BBC Online readers would have found these views less important and credible than, say, those of General Casey and Fred Kaplan? If so, why? If not, why did you ignore them?"

Reynolds responded that he had amended the article to include expert commentary "from Prof Burnham of JH [Johns Hopkins] and another from Ronald Waldman, an epidemiologist at Columbia". (October 13, 2006)

Conclusion

The media response to the latest Lancet report consisted of initial, relatively high-profile coverage in the broadcast media and more subdued coverage in some print media. Coverage focused heavily on government dismissals and on the alleged 'controversy' surrounding the figures. Expert commentators were few and far between, with journalists exhibiting the usual confusion on the methodology behind, and significance of, the figures. Passing mentions aside, the story was dropped within 24 hours from media coverage, with essentially zero meaningful follow up reporting or analysis since.

Journalists did respond with considerably less scepticism than after the 2004 Lancet report was published. However, the extent of coverage has, if anything, been less than in 2004. To its credit, Newsnight interviewed Les Roberts - a rare chance for one of the report's co-authors to defend the study. On his BBC blog, Newsnight editor Peter Barron revealed that internet-based activism had been a factor in Newsnight's coverage of the story:

"When the story broke of the Lancet report into civilian deaths in Iraq it was accompanied by a rash of e-mails from anti-war groups urging us to run the story. Did that influence us?

"Well, yes in the sense that I learned of the story from an anti-war campaigner who e-mails me regularly. But also no. When I took the report into our morning meeting where none of the producers had yet seen it, there was instant and unanimous agreement that - while the claim was in some people's view not credible - it was easily the most significant development of the day."

Barron added:

"Are these unsolicited interventions helpful or unhelpful? The former, I think, as long as we read them with eyes wide open. You might argue that it would be purer to ignore the pressure from all quarters, but I think lobbying can actually improve our journalism, as long as it's not corrupt, that access to the editors of programmes is equally available to everyone (via e-mail it is) and that we question everything we're told."(http://www.bbc.co.uk/blogs/theeditors/2006/10/600000_killed_is_that_a_story.html)

But Newsnight's coverage was a rare departure from the norm of stunning media indifference. Where are the in-depth media analyses, expert interviews and investigations? Where the leaders, documentaries and news specials comparing the various death tolls reported from Iraq?

Where are the articles and programmes examining US-UK responsibility under international law, as occupying powers, for the catastrophe in Iraq? Where the discussions of the abject failure of modern democracy to offer either the British or American people any semblance of meaningful choice on foreign policy?

We have been monitoring and reporting media performance for five years, since July 2001. The current media response to a credible report that our government is responsible for the deaths of 655,000 Iraqis is the most shocking and outrageous example of media conformity to power we have yet seen.

The implications are clear - no crimes of state are too monstrous or extreme for mainstream journalism. There is no limit to their willingness to obscure the depredations of power. The corporate media, the liberal media very much included, is a grand lie - an apparent source of reason and hope that betrays the people it serves at every turn.

SUGGESTED ACTION

The goal of Media Lens is to promote rationality, compassion and respect for others. In writing letters to journalists, we strongly urge readers to maintain a polite, non-aggressive and non-abusive tone.

Ask the editors below why they have given so little coverage to the credible report that the March 2003 British and American invasion of Iraq has resulted in the excess deaths of 655,000 Iraqis.